Provider Demographics
NPI:1457602732
Name:MCKINLEY, JESSICA M (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MCKINLEY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11163 LA QUINTA PL
Mailing Address - Street 2:SUITE B100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5255
Mailing Address - Country:US
Mailing Address - Phone:915-219-8833
Mailing Address - Fax:
Practice Address - Street 1:7845 N MESA ST STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1623
Practice Address - Country:US
Practice Address - Phone:915-206-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126981363LF0000X, 363L00000X
IN71004159A363LF0000X
FLAPRN11034052363LF0000X
MO2024042280363LF0000X
NV880558363LF0000X
VA0024191816363LF0000X
COC-APN0103176-C-NP363LF0000X
UT14205895-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily